ROUTINE PREOPERATIVE CHEST X-RAY AND ITS IMPACT ON DECISION MAKING IN PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES

Authors

  • Irum Sabir Ali
  • Mumtaz Khan
  • Muhammad Atif Khan

Abstract

Background: It is the routine of our hospital that all patients undergoing any kind of surgery in any specialty are subjected to routine pre-op chest x-ray (CXR). However there is increasing evidence that this practice does not have much influence on patient management and thus could be limited to a very small number of patients in whom it is justified. We conducted this study to know the significance of routine pre-op x-rays chest in patients admitted in a surgical unit for elective surgery and to what extent such routine x-ray affected our surgical intervention. Methods: It is a cross sectional study in which 500 consecutive adult patients admitted in surgical ‘C’ unit of Lady Reading Hospital Peshawar, for elective surgical procedures were included. The age, gender, co-morbidity, delay in operation if any was recorded and CXR were reported upon by a qualified radiologist. The influence on decision making regarding fitness of patients for general anaesthesia/surgery was also determined.  Data were analysed using SPSS-20. Results: Out of total of 500 chest x-rays 109 (21.8%) were reported to have some abnormality in the film. Out of these 109, 58 were male 51 were female patients. The percentages of abnormal CXR according to age were 13.6%, 35.8%, and 50% in the 16–39 years, 40–69 years and ≥70 year age groups respectively. Amongst the patients with abnormal CXR, 30 had their surgery delayed. However in only one patient out of the 30 the delay was on the basis of significant finding on the CXR. Conclusion: Good medical history and clinical examination can save many patients from unnecessary CXR. Preoperative CXR may only be done in patients who have a clear indication for this investigation.Keywords: Surgery, impact, Chest X-ray, pre-operative, fitness, anaesthesia

References

X-rays. Available at: http://www.nobelprize.org/educational/ physics/x-rays/ [Cited on: 28 Oct 2012].

Joo HS, Wong J, Naik VN, Savoldelli GL. The value of screening preoperative chest x-rays: a systematic review. Can J Anaesth 2005;52:568–74.

Sommerville TE, Murray WB. Information yield from routine pre-operative chest radiography and electrocardiography. S Afr Med J 1992;81(4):190–6.

Nze PU, Njike C. Is routine preoperative chest X-ray indicated in elderly patients undergoing elective surgery? Niger J Med 2008;17(2):150–2.

Sharma GK. Preoperative Testing. Available at: http://emedicine.medscape.com/article/285191-overview#a1 (Cited on: 20-11-2013)

Kaplan EB, Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN, et al. The usefulness of preoperative laboratory screening. JAMA 1985;253:3576–81.

Turnbull JM, Buck C. The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med 1987;147:1101–5.

Archer C, Levy AR, MeGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth 1993;40;1022–7.

Ishaq M, Kamal RS, Aqil M. Value of routine pre-operative chest X-ray in patients over the age of 40 years. J Pak Med Assoc 1997;47(11):279–81.

Bouillot JL, Paquet JC, Hay JM, Coggia M. [Is preoperative systematic chest x-ray useful in general surgery? A multicenter prospective study of 3959 patients. ACAPEM. Association des Chirurgiens de l’Assistance Publique pour les Evaluations Médicales.] Ann Fr Anesth Reanim 1992;11(1):88–95. [Article in French]

García-Miguel FJ, García Caballero J, Gómez de Caso-Canto JA. [Indications for thoracic radiography in the preoperative evaluation for elective surgery.] Rev Esp Anestesiol Reanim 2002;49(2):80–8. [Article in Spanish]

Vesconi S, Riedo R, Ciceri G, Rusconi MG. [Protocol for preoperative chest X-rays in elective surgery.] Minerva Anestesiol 2000;66(1–2):11–6. [Article in Italian]

Escolano F, Alonso J, Gomar C, Sierra P, Castillo J, Castaño J. [Usefulness of preoperative chest radiography in elective surgery.] Rev Esp Anestesiol Reanim 1994;41(1):7–12. [Article in Spanish]

Jeavons SJ, Siddgle KJ, Mitchell C, O’Hare PM. Evaluation of pre-operative chest x-ray. Australasian Radiology 1987:31(3):256–9.

Yves C, Blery C, Chastang C, Szatan M, Fourgeaux B. Prospective assessment of a protocol for selective ordering of preoperative chest x-rays. Can J Anaesth 1988:35(3):259–64.

Ogunseyinde AO. Routine pre-operative chest radiographs in non-cardiopulmonary surgery. Afr J Med Sci 1988;17(3):157–61.

Bhuripanyo K, Prasertchuang C, Chamadol N, Laopaiboon M, Bhuripanyo P. The impact of routine preoperative chest X-ray in Srinagarind Hospital, KhonKaen. J Med Assoc Thai 1990;73(1):21–8.

Panich A, Panjasawadwong Y. Routine preoperative chest roentgenogram and its impact on intraoperative complications. J Med Assoc Thai 1994;77(9):477–83

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Published

2013-06-01

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